=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376936419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREGIVERS OF MISSISSIPPI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2015
-----------------------------------------------------
Last Update Date | 03/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6668 U S HIGHWAY 98
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-7981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-270-9862
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 18557
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39404-8557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-270-9862
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. BIX JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-270-9862
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------